Provider Demographics
NPI:1295198109
Name:SMITH, DAMITRA (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:DAMITRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:DAMITRA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7823
Mailing Address - Country:US
Mailing Address - Phone:832-449-6823
Mailing Address - Fax:
Practice Address - Street 1:2717 COMMERCIAL CENTER BLVD STE E200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7823
Practice Address - Country:US
Practice Address - Phone:832-449-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13292101YA0400X
TX80480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)